Basic Information
| Provider Information | |||||||||
| NPI: | 1093193666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORN | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 57 PUTNAM DR | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105125653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148442387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 FAMILY PRACTICE DR | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124016449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453382562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 096992 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | WVE061 | 01 | NY | MEDCIARE # | OTHER | 1285628552 | 01 | NY | AGENCIES | OTHER | 00355940 | 05 | NY | MEDICAID |